War Surgery and Medicine
IN 2 NZEF the most striking feature of ophthalmology was its quantity, and it seemed that men tended to be more intolerant of small disabilities than they were in the First World War. Lieutenant-Colonel Barrett, writing of the work of 1 Australian General Hospital at Heliopolis during the Gallipoli campaign, a hospital of about 2700 beds, described its ophthalmic clinic as ‘enormous’. During the eight months of its existence 1142 cases were seen. In the eight months preceding the offensive at El Alamein, 2380 new ophthalmic cases were seen at 1 NZ General Hospital at Helwan.
There were four main reasons for the volume of work. Firstly, the medical boarding of recruits in New Zealand was uneven and a number of unfit men were sent abroad. Secondly, service glasses were not available in New Zealand until after the 4th Reinforcements had sailed, and the 5th, 6th, and 7th Reinforcements were equipped with them only in part. Thirdly, ophthalmic work was concentrated at the Helwan hospital, an area hospital serving not only New Zealand base but also many thousands of RAF and British troops. Lastly, owing to the discomfort from glare and the presence of so much ocular disease and blindness amongst the natives, many men were unreasonably apprehensive about their sight. Among the more imaginative soldiers, especially those with any reason to be aware of ocular weakness, the presence of so many partially blind and disfigured natives was attributed to the climatic conditions. From the beginning, therefore, and in spite of the pressure of work, a determined effort was made by explanation and reassurance to give the men some confidence. This time was undoubtedly well spent. Discomfort from glare in Egypt can be considerable, and this, together with prevalent mild conjunctivitis, tended to unmask errors of refraction previously tolerated and make men more dependent on glasses for carrying out their duties with comfort and efficiency.
The supply of spectacles in Egypt was inadequate until late in 1942. When Major Doctor arrived in November 1940 he began to refract for service frames all those of the first three echelons who were wearing spectacles. This laborious task was just completed when Major (later Lieutenant-Colonel) Coverdale succeeded page 429 him at Helwan, but the shortage at that time was so acute that only fifteen pair were being dispensed for the hospital by the army contractor each month. There was a long and rapidly increasing waiting list of about 270 New Zealand prescriptions, and men had to wait two to four months even when their need was urgent. It was not until 1943 that, owing to the work of the Opticians' Units in New Zealand, drafts arrived in the Middle East well investigated and equipped and with almost all optically unfit men withdrawn. This ultimate relief for the ophthalmologist abroad, however welcome, was achieved by a very high rejection rate in New Zealand, and there is no doubt that the whole question of standards would repay careful study.
In June 1944 the 14th Mobile Optician Unit, extremely well equipped and under the command of Lieutenant F. O. Davis, arrived in Italy. Its inception was attended by some misfortunes and it was not able to give a complete service until late in the year. Thereafter it proved to be a valuable acquisition.
Many hundreds of men complained of the light, but no corneal changes were visible with the loupe and it was probable that the great majority suffered, not from actinic burns, but from the intensity of the visible rays. The experience of three summers enabled Coverdale to classify most of these men into three groups: (1) those whose eyes were hypersensitive because of superficial inflammations of the lids or conjunctiva, often of a very mild sort; (2) those whose ocular muscles were in a state of irritable tension from uncorrected errors of refraction; (3) those whose nervous systems in general and eyes in particular were intolerant of stimuli because of functional instability.
Men were never discouraged from attending hospital as outpatients, and when subjective disability was out of all proportion to objective findings much time and energy had to be spent in clearing the miasma of minor psychoneurosis from discoverable fact; but Major Coverdale was satisfied that, if it occurred at all, wilful simulation of incapacity was exceedingly rare amongst New Zealand and British troops. Psychoneurosis was fairly common in 1941, much less so in 1942, and thereafter almost ceased to occur. This improvement was ascribed, at least in part, to better boarding in New Zealand. It was found that amongst 95 cases of hysterical amblyopia there were 44 with eyes defective at enlistment from squint, old injury, chronic disease or developmental defects, and 9 with histories of pre-enlistment head or eye injuries, but with no signs remaining. Most of the affected men paraded sick soon after arrival in Egypt, and very few indeed were sent back from forward units in the field. Apart from a few hysterics and some cases with pathological changes, night-blindness was not heard of in 2 NZEF.page 430